Street children and youth are a vulnerable and often stigmatized group at risk for many negative health outcomes. Despite being disproportionately affected by the HIV pandemic, they have been generally neglected in HIV prevention research.

Colette "Coco" Auerswald, associate professor at the UC Berkeley School of Public Health; JMP student Ariella Goldblatt; and their research team conducted a study, the first of its kind, that measured the prevalence and risk factors for HIV among street youth in Kenya, rather than measuring knowledge, attitudes, and behaviors related to HIV, which has been the focus of most existing research to date. The study, lead by Auerswald and Goldblatt, was published in October in the journal PLOS One.

The research took place in 2012 in Kisumu, Kenya in collaboration with the Kenya Medical Research Institute and local community organizations working with street children and youth.

A sample of almost 300 male street youth, most of them orphans, participated in demographic and behavioral surveys as well as voluntary HIV counseling and testing. Participants who were HIV positive were linked to care at a local clinic providing adolescent friendly free HIV treatment and care services.

The study found that the HIV prevalence among study participants was four percent. This is similar to the prevalence of HIV among housed youth of the same age in the area, dispelling the common misconception of very high rates of HIV infection among street youth.

The study also identified several risk factors that were associated with HIV infection, including homelessness for at least a year, vaginal sex, and anal sex, which, in this setting, is often used as a means of initiation into street gangs or a way for older youth to establish dominance over newcomers to the street. Also certain street survival activities such as helping market vendors and working as domestic workers were related to increased risk of HIV infection. It is hypothesized that these activities place youth at particular risk of coercion by older adults.

Glue use, a substance commonly used by street youth (46 percent among research participants), but less common among housed youth was associated with increased risk of engaging in activities associated with coercion by adults and is thereby indirectly related to increased risk of HIV infection.

Although the study found that the overall prevalence of HIV was not higher than that of young men in the general population of Kisumu, it does offer insight into possible interventions that could reduce the risk of HIV among this street youth. Engaging youth in school and providing alternative economic activities where street youth are not vulnerable to exploitation by adults could help prevent transmission. Since all participants who tested positive for HIV had been on the street for at least a year, shelters and family or community reunification programs are potential interventions. Finally, addressing glue use, primarily by making glue less available to street youth is an intervention that would improve overall health and possibly reduce HIV infections.

“The study demonstrated that it is acceptable to do HIV testing and linkage to care in street children and youth. It also provides several targets for interventions to prevent HIV infection among this population,” says Auerswald. “Future efforts involving pilot interventions to prevent HIV infection in this population are important next steps.”

Co-authors of the study include Maureen Lahiff, Alexandra Minnis, Jessica Lin, all three from the UC Berkeley School of Public Health; Ndola Prata from the Bixby Center for Population, Health and Sustainability at the UC Berkeley School of Public Health; Zachary Kwena, from the Kenya Medical Research Institute; Kawango Agot from the Impact Research and Development Organization in Kisumu, Kenya; and Elizabeth A. Bukusi from the Kenya Medical Research Institute.

Funding was provided by the UC Berkeley Center for Global Public Health, the UC Berkeley-UCSF Joint Medical Program, Albert Brodie Smith and Margaret Gretchen Smith Scholarship, the UCSF Department of Pediatrics, and the UC Berkeley-UCSF Joint Medical Program Schoeneman Grant.